Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks

Tsay, Ellen L.; Grace, Trevor; Vail, Thomas P.; Ward, Derek

doi:10.1016/j.arth.2019.07.002

Cited by 37 publications

(36 citation statements)

References 15 publications

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“…6 This supports a move back to simultaneous bilateral TKA. In a study by Tsay et al, 7 the absolute clinical difference in complication rates between staged and simultaneous bilateral TKA was shown to be minimal (< 1%) when analyzing over 70,000 knees that were operated on bilaterally (either staged or simultaneous).…”

Section: Introductionmentioning

confidence: 98%

Simultaneous bilateral total knee arthroplasty

2022

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Aims Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. Methods This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores. Results In total, 315 patients (630 knees) were included for analysis. Of these, functional scores were available for 189 patients (378 knees). There was a 1.9% (n = 12) all-cause revision rate for all knees. Overall, 12 knees in ten patients were revised, and both right and left knees were revised in two patients. The OKS and patient satisfaction scores were comparable for trainees and supervising surgeons. A majority of patients (88%, n = 166) were either highly likely (67%, n = 127) or likely (21%, n = 39) to recommend bilateral TKAs to a friend. Conclusion Simultaneous bilateral TKA can be used as an effective teaching model for trainees without any significant impact on patient clinical or functional outcomes. Excellent functional and clinical outcomes in both knees, regardless of whether the performing surgeon is a trainee or supervising surgeon, can be achieved with simultaneous bilateral TKA. Cite this article: Bone Jt Open 2022;3(1):29–34.

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Section: Introductionmentioning

confidence: 98%

Simultaneous bilateral total knee arthroplasty

2022

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“…Bilateral TKR can be achieved at the same time under the same anesthetic or in steps, with two unilateral knee arthroplasties performed independently under separate anesthetics and hospitalizations. Simultaneous bilateral TKR is a simple and comfortable treatment that has been linked to higher patient satisfaction, quicker healing, and reduced cost [5][6][7]. While the staged bilateral TKR can reduce the risk of complications, it has been linked to higher hospitalization costs [7].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Frequency and Morbidity of Unilateral Total Knee Replacement Versus Simultaneous Bilateral Total Knee Replacement

Arif¹,

Hafeez²

2022

Cureus

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IntroductionTotal knee replacement (TKR) is a procedure that is often performed on patients who have advanced osteoarthritis and has become more common. Bilateral TKR can be done at the same time and can save time, anesthesia and cost of multiple procedures. ObjectiveTo determine the frequency of unilateral and simultaneous bilateral total knee replacement and then compare their outcomes. MethodsA total of 95 patients were included and were divided into two groups, i.e., patients undergoing unilateral TKR were grouped as group A and patients undergoing bilateral TKR were grouped as group B. Then patients underwent surgery under general anesthesia. All patients were followed up in the outpatient department (OPD). During follow-up, patients were evaluated for the outcome, i.e., cardiac event, urinary tract infection and surgical site infection. All this information was recorded on proforma while analyzed in SPSS v. 22 (IBM Corp., Armonk, NY). The outcome was compared in both groups by using chi-square test. The P-value ≤ 0.05 was considered as significant. ResultsThe mean age of patients was 63.00 ± 6.17 years. There were 50 (52.6%) males and 45 (47.4%) females. The mean BMI of females was 27.93 ± 2.43 kg/m 2 . There were 47 (49.5%) patients who underwent simultaneous bilateral surgery while 48 (50.5%) underwent unilateral surgery. It has been observed that after surgery, the cardiac event occurred in one (1.1%) case and that case was from unilateral surgery group; urinary tract infection occurred in four cases, two (4.3%) were from bilateral cases while two (4.2%) were from the unilateral group and surgical site infection occurred in four cases, two (4.3%) were from bilateral cases while two (4.2%) were from the unilateral group. The difference was insignificant in both groups (p>0.05). ConclusionThus, there was no significant difference observed between both groups regarding complications after surgery.

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“…Em todo o mundo, a expectativa de vida vem aumentando (1). À medida que a população envelhece, a prevalência de osteoartrite (OA) do joelho e, portanto, a demanda por artroplastias totais crescem (2,3). O quantitativo mundial de cirurgias para substituição total do joelho deve atingir 3,48 milhões por ano até 2030, representando um aumento de 675% em relação a 2005 (2,4).…”

Section: Introductionunclassified

Artroplastia total de joelho bilateral simultânea versus estadiada: uma análise retrospectiva transversal de desfechos clínico subjetivos, hospitalares e funcionais

Lyra¹,

Teixeira²,

Oliveira³

2022

PIC

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Atualmente a demanda por artroplastia de joelho vem aumentando devido aoenvelhecimento populacional e suas repercussões físicas, mas ainda existe um debatecientífico sobre qual a técnica mais apropriada: Bilateral simultânea ou estadiada. Em virtudedisso, o objetivo desse estudo foi comparar desfechos clínicos e hospitalares em pacientesdiagnosticados com osteoartrite que foram submetidos a um dos procedimentos, operadospor um mesmo cirurgião no Hospital Ortopédico e Medicina Especializada (HOME), na cidadede Brasília/DF-Brasil, a partir de 2010, desde que o tempo transcorrido entre o procedimentocirúrgico e as coletas fosse maior do que um ano. Foram divididos em dois grupos de análise:Artroplastia total de joelho bilateral simultânea (ATJBS) e Artroplastia total de joelho bilateralestadiada (ATJBE). Os dados antropométricos, incluindo gênero, idade, altura, peso ecomorbidades crônicas diagnosticadas antes da primeira artroplastia foram coletados, alémde desfechos clínicos (primários) e hospitalares (secundários). Desfechos primários: avaliaçãode capacidade funcional auto relatada por meio do questionário Western Ontario andMcMaster Universities Osteoarthritis Index (WOMAC); saúde funcional e o bem-estar peloquestionário 36-Item Short-Form Health Survey; grau de satisfação com a cirurgia utilizandoum questionário com escala fixa. Secundários: tipos e frequência de complicações póscirúrgicas (cardíacas, respiratórias e infecciosas) e tempo de permanência total no hospital(dias) após o procedimento. A comparação entre os grupos nos valores do WOMAC nãodemonstrou diferença estatística (p=0,25). De forma semelhante, nenhuma diferença foiobservada entre os dois grupos para os valores do SF-36 global (p=0,63) e das subescalasanalisadas: capacidade funcional (p=0,44), aspectos físicos (p=0,44), dor (p=0,56) e saúdegeral (p=0,42). Uma análise das frequências de satisfação dos pacientes evidenciou osresultados: muito ruim (ATJBS: 1/36; ATJBE: 0/14), ruim (ATJBS: 0/36; ATJBE: 0/14), regular(ATJBS: 3/36; ATJBE: 0/14), bom (ATJBS: 2/36; ATJBE: 1/14), muito bom (ATJBS: 10/36; ATJBE:6/14) e ótimo (ATJBS: 20/36; ATJBE: 7/14. A análise das complicações constatou o seguinte:complicações cardíacas (ATJBS: 5/37; ATJBE: 2/14); complicações respiratórias (ATJBS: 1/37;ATJBE: 0/14) e infecções (ATJBS: 0/37; ATJBE: 1/14). Não foi evidenciado diferença estatísticaentre os grupos (p=0,71). A análise da frequência global de complicações demonstrou:complicações/sim (ATJBS: 6/37; ATJBE: 3/14) e sem complicações/não (ATJBS: 31/37; ATJBE:11/14). O tempo de internação foi estatisticamente menor no grupo ATJBS quandocomparado ao grupo ATJBE (p=0,001). Em conclusão, os resultados apontaram que a ATJbilateral simultânea gerou resultados similares na avaliação de capacidade funcionalreportada (WOMAC), saúde funcional e o bem-estar (SF-36) e satisfação do paciente com oresultado cirúrgico, quando comparada à estadiada. Além disso, os dois procedimentos foramsemelhantes no que diz respeito a complicações no pós-operatório. No entanto, houvediferença estatisticamente significativa no tempo total de internação hospitalar, evidenciadopela redução em dias, nos pacientes que realizaram ATJ bilateral simultânea.

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Bilateral Simultaneous vs Staged Total Knee Arthroplasty: Minimal Difference in Perioperative Risks

Cited by 37 publications

References 15 publications

Simultaneous bilateral total knee arthroplasty

Simultaneous bilateral total knee arthroplasty

Comparison of Frequency and Morbidity of Unilateral Total Knee Replacement Versus Simultaneous Bilateral Total Knee Replacement

Artroplastia total de joelho bilateral simultânea versus estadiada: uma análise retrospectiva transversal de desfechos clínico subjetivos, hospitalares e funcionais

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